Patients with Acute Coronary Syndromes: Decreasing Time to Electrocardiogram

Patients with Acute Coronary Syndromes: Decreasing Time to Electrocardiogram

Abstract:

Patients with Acute Coronary Syndromes: Decreasing Time to Electrocardiogram

Conference Sponsor:

Emergency Nurses Association

Conference Year:

2007

Author:

Mahone, Patricia, RN, BSN

P.I. Institution Name:

Cleveland Clinic,

Title:

Assistant Nurse Manager

Contact Address:

9500 Euclid Ave., E12, Cleveland, OH, 44195, USA

Contact Telephone:

(216) 444-0175

Email:

mahonep@ccf.org

Co-Authors:

Carmel Matteo, RN, BA

[Clinical Poster] Clinical Topic: The current method for triaging acute coronary syndromes (ACS) patients when there is no bed available in the emergency department (ED) was to send them to the triage workroom after nurse triage for an electrocardiogram (ECG) and labs for point-of-care testing. This method required too much time as similar patients (also in need of an ECG) were not being taken care of in a timely manner. A quality review showed that many ACS patients had atypical symptoms with a delay to ECG which then revealed ST-segment elevation myocardial infarction (STEMI) resulting in a delay in time to cardiac catheterization. The purpose of this project was to have these patients bypass triage to until the ECG was completed (within ten minutes of arrival) so as to rapidly identify patients who were having an acute myocardial infarction (AMI) or other ACS.

Implementation: A process improvement plan in June 2006 identified areas for improvement which changed triage practice. This included obtaining an ECG prior to the triage nurse's assessment, starting an intravenous line, and drawing blood for testing. Appropriate teaching needs for nurses, paramedics, and clinical technicians were identified. Education was provided on the atypical symptoms of ACS, including badge backers for the nursing staff and in-services provided by the clinical nurse specialist. ESI triage categories assigned by the triage nurse determined where the patient would go. Patients who met ESI category 1 or 2 would go to the main emergency department. ESI category 3 patients received an ECG in triage. If necessary, beds in other areas of the emergency department were used for ECGs. The ECG results (and previous ECG results, if available) were reviewed by an attending physician to determine if an ACS was present. In the triage area itself, the assigned clinical technicians or paramedics were empowered to bring patients with chest pain complaints directly to the workroom for an ECG. The triage nurse may also send the patient to the workroom for an ECG if additional anginal symptoms were present. Initially, there was difficulty in bypassing triage so the patients would receive their ECG first.

Outcomes: Time to ECG has improved to below 10 minutes for STEMI and other ACS since this clinical project began in 2006. Data for July to December 2006 was compared with data from January to June 2006. Median time to ECG for AMI decreased from 13 to 6.5 minutes (a 50% decrease). With patients experiencing chest pain, the median time decreased from 14.5 to 8 minutes. Total ECG time, including symptoms other than chest pain, decreased from 15 to 11 minutes.

Recommendations: ACS remains a high-risk and common diagnosis in emergency departments. As women, elderly, and diabetic patients do not typically present with classic chest pain, it is important to continually educate all ED staff on the less common ACS symptoms and the importance of timely ECGs. Although there was a learning curve in educating the triage nurses to let the technical staff perform the ECG first, many times now, the triage nurse is getting the initial assessment during the ECG process. Other symptoms still need continued improvement in their rapid identification including weakness and/or shortness of breath.

Full metadata record

Patients with Acute Coronary Syndromes: Decreasing Time to Electrocardiogram

en_GB

dc.identifier.uri

http://hdl.handle.net/10755/162662

-

dc.description.abstract

<table><tr><td colspan="2" class="item-title">Patients with Acute Coronary Syndromes: Decreasing Time to Electrocardiogram</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mahone, Patricia, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cleveland Clinic,</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Nurse Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value"> 9500 Euclid Ave., E12, Cleveland, OH, 44195, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(216) 444-0175</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mahonep@ccf.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Carmel Matteo, RN, BA</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: The current method for triaging acute coronary syndromes (ACS) patients when there is no bed available in the emergency department (ED) was to send them to the triage workroom after nurse triage for an electrocardiogram (ECG) and labs for point-of-care testing. This method required too much time as similar patients (also in need of an ECG) were not being taken care of in a timely manner. A quality review showed that many ACS patients had atypical symptoms with a delay to ECG which then revealed ST-segment elevation myocardial infarction (STEMI) resulting in a delay in time to cardiac catheterization. The purpose of this project was to have these patients bypass triage to until the ECG was completed (within ten minutes of arrival) so as to rapidly identify patients who were having an acute myocardial infarction (AMI) or other ACS.<br/><br/>Implementation: A process improvement plan in June 2006 identified areas for improvement which changed triage practice. This included obtaining an ECG prior to the triage nurse's assessment, starting an intravenous line, and drawing blood for testing. Appropriate teaching needs for nurses, paramedics, and clinical technicians were identified. Education was provided on the atypical symptoms of ACS, including badge backers for the nursing staff and in-services provided by the clinical nurse specialist. ESI triage categories assigned by the triage nurse determined where the patient would go. Patients who met ESI category 1 or 2 would go to the main emergency department. ESI category 3 patients received an ECG in triage. If necessary, beds in other areas of the emergency department were used for ECGs. The ECG results (and previous ECG results, if available) were reviewed by an attending physician to determine if an ACS was present. In the triage area itself, the assigned clinical technicians or paramedics were empowered to bring patients with chest pain complaints directly to the workroom for an ECG. The triage nurse may also send the patient to the workroom for an ECG if additional anginal symptoms were present. Initially, there was difficulty in bypassing triage so the patients would receive their ECG first. <br/><br/>Outcomes: Time to ECG has improved to below 10 minutes for STEMI and other ACS since this clinical project began in 2006. Data for July to December 2006 was compared with data from January to June 2006. Median time to ECG for AMI decreased from 13 to 6.5 minutes (a 50% decrease). With patients experiencing chest pain, the median time decreased from 14.5 to 8 minutes. Total ECG time, including symptoms other than chest pain, decreased from 15 to 11 minutes.<br/><br/>Recommendations: ACS remains a high-risk and common diagnosis in emergency departments. As women, elderly, and diabetic patients do not typically present with classic chest pain, it is important to continually educate all ED staff on the less common ACS symptoms and the importance of timely ECGs. Although there was a learning curve in educating the triage nurses to let the technical staff perform the ECG first, many times now, the triage nurse is getting the initial assessment during the ECG process. Other symptoms still need continued improvement in their rapid identification including weakness and/or shortness of breath.</td></tr></table>

en_GB

dc.date.available

2011-10-27T10:32:00Z

-

dc.date.issued

2011-10-17

en_GB

dc.date.accessioned

2011-10-27T10:32:00Z

-

dc.description.sponsorship

Emergency Nurses Association

en_GB

All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.